Clinical Implications of Appearance of Pleural Fluid at Thoracentesis

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Passom Sueyunyongsiri

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Study objectives: The aims of this study were to describe the different appearances of pleural fluid during thoracentesis and their frequency in relation to diagnosis, and to evaluate the causes and clinical implications of bloody pleural effusions.
Setting: Secondary care, 600 beds Sunrin hospital.
Subjects and methods: One hundred twenty-four patients with pleural effusion were retrospectively assessed from October 2003 to September 2004.
Results: Pleura! effusions developed in 124 hospital admissions. Their sizes were small (27%), moderate (48%), large (20%), and loculated (5%). The associated conditions were infectious: pulmonary tuberculosis (n = 37), bacterial pneumonia (n = 21), empyema (n = 9), parasitic disesas (n =5) and Dengue hemorrhagic fever (n=2); and noninfectious: paramalignancy (n=9), malignancy (n = 6), hepatic cirrhosis (n = 6), pancreatitis (n = 3), congestive heart failure (n = 3), atelectasis (n = 3), hypoatbu-minemia (n = 2), renal failure (n = 1). The most common presentations were serous and blood tinged, with 82% of the fluids fitting into one of these categories. The most frequent cause of serous fluid was tuberculosis. There were 18 bloody and 67 nonbloody pleural fluids. The most common cause of bloody pleural effusion (BPE) was malignancy (32%). Nevertheless, only 36% of the neoplastic effusions were BPE. Other common causes of BPE were parapneumonic (21%) or parasitic dis-eases(16%) pleural effusions. Tuberculosis was the most common causes of pleural effusion. Fluid that was bloody fluid in appearance, increased the probability for neoplasm and parasitic disease(OR, 3.2; 95% CI, 2.02 to 4.42; p = 0.05 and OR, 5.65; 95% CI, 3.79 to 7.51; p = 0.05, respectively).
Conclusions: Serous and blood tinged were the most common presentations of pleural fluid at thoracentesis. Almost half of BPEs were secondary to neoplasms, but only 32% of the neoplastic effusions were BPEs. Other common causes of BPE were parapneumonic and parasitic diseases.
Key Words: bloody appearance, pleural effusion, pleural tuberculosis

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